News / News review December 2014

The National Audit Office kicked off November with its examination of the financial position of the NHS in England. Its report, The financial sustainability of NHS bodies, said the trend of growing financial stress in NHS trusts and foundation trusts was not sustainable. At the end of June, NHS trusts forecast a net deficit of £404m and foundations £108m, compared with plans for deficits of £425m and £20m, respectively. Monitor and the NHS Trust Development Authority have since updated these figures (see page 3). The NAO also highlighted the £500m given to trusts in severe financial difficulty in-year and the £377m overspend on specialised commissioning in 2013/14. The 30% marginal rate emergency tariff had failed to contain demand and there was considerable uncertainty over the impact of the better care fund, it added.

 The report was picked up by the Commons Public Accounts Committee. Evidence sessions for its inquiry included contributions from HFMA president Andy Hardy (see p4) and Department of Health director general of finance and NHS Richard Douglas (left). Asked about the impact of the private finance initiative on deficits, Mr Douglas said that while a number of trusts in deficit had PFI schemes, including four of the six with deficits greater than £25m, other providers with PFIs were doing well. He did not believe there would be many cases where a PFI buy-out would be affordable and value for money.

 Amid rumours that the autumn statement could see additional funding for the NHS next year – and with Liberal Democrat health minister Norman Lamb urging the chancellor to release an extra £1.5bn in 2015/16 to prevent a ‘crash’ in services – the Department of Health announced an additional £300m for frontline care over the winter. The funding, which comes on top of the £400m announced earlier in the year, will provide more beds and pay for additional staff, the Department said. Health secretary Jeremy Hunt said that with the extra resources he expected the NHS to deliver a strong performance.

 Foundation Trust Network chief executive Chris Hopson (below) said NHS finances must be sorted out. At the FTN annual conference, he said the NHS faced the choice of reducing the care it commissions and provides or increasing funding to meet growing demand. The health service was not funded to meet demand, and investment was needed to implement the ambitious Five-year forward view. Investment for transformation was one of four themes identified in the FTN’s programme for the next parliament. It identified priorities as follows:

• Multi-year funding and planning
• Staffing decisions to be based on local clinical judgements, not blunt national targets
• Regulators being held to account for providing value for money
• Higher standards being set for local and national commissioners.

 Pay continued to dominate the headlines, with agenda for change (AFC) staff in Northern Ireland and England taking industrial action over the government decision this year to pay the recommended 1% rise only to those not eligible for incremental pay. However, trade unions and the Welsh government agreed a deal for NHS staff on AFC contracts. The Wales-only deal includes a 1% consolidated uplift for all AFC staff from April 2015. The living wage will be introduced for directly employed staff from 1 January 2015. All AFC staff in post on 1 December this year will be eligible for a non-consolidated, non-pensionable, lump sum of £187 (full-time equivalent), to be paid in January, and employed staff will continue to receive incremental pay progression.

 The government asked the doctors’ and dentists’ pay review body to examine consultant and junior doctor contracts after the breakdown of negotiations between the British Medical Association and NHS Employers in October. NHS Employers said the review body had been asked to comment on consultant contract reform and a new contract for juniors. The review body is expected to report back to the government in July 2015.

 An Employment Appeal Tribunal decision that some overtime pay should be included when calculating holiday pay will have alarmed many NHS employers who could be worried about back claims from employees. There is likely to be an appeal on the ruling next year. In the meantime, NHS Employers advised that, when calculating holiday pay, employers should include overtime where employees are carrying out their contractual duties.

 The safety and quality of NHS services for patients remained under scrutiny in November, following the publication of performance data for almost 5,000 surgeons in England. The information, which allows patients to search a range of data including the mortality rates for individual surgeons, immediately came under fire. Some surgeons claimed the data could be crude and misleading and that vital information, such as length of stay, was missing.

 NHS England announced that it is minded to have four tranches of clinical commissioning groups to procure commissioning support services under the lead provider framework next year. This represented its initial thoughts on the roll-out of the framework. NHS England said the tranches – in February, April, June and September – would ensure CCGs received sufficient support and help suppliers concentrate their resources on putting together their best bids. NHS England said it had been contacted by more than 30 CCGs who wished to use the framework as soon as possible and it encouraged others to join them.

 MPs criticised NHS England’s oversight of the value for money of out-of-hours GP services. In a report, the Commons Health Committee said there was no information to allow clinical commissioning groups to benchmark the cost and quality of out-of-hours services. NHS England also needed to take steps to understand the variations in cost and quality across the country – the cost per case ranged from less than £29 to more than £134 in 2013/14. Out-of-hours GP services in England added that CCGs were not managing potential conflicts of interest when commissioning the services and the redesign of urgent and emergency care services should be expedited. The latter would address the misalignment of incentives and promote treatment in the most appropriate setting and the most effective use of resources.

 NHS England has urged clinical commissioning groups to explore the new Commissioning for value pathways on a page packs. This would help commissioners identify priorities that offer the best opportunities for improvement in terms of spending and outcomes and support the transformation outlined in the Five-year forward view.

 The Scottish government extended its non-profit distributing (NPD) programme for the delivery of capital development to 2019/20. The then deputy first minister, Nicola Sturgeon (above) announced a £409m investment package, which includes £120m for the Royal Edinburgh Hospital Campus to complete its redevelopment and £65m for the East Lothian Community Hospital project. Ms Sturgeon, a former Scottish health secretary, took over as Scotland’s first minister when Alex Salmond stepped down. She has promoted Shona Robison to health secretary, while the former holder of that post, Alex Neil, has become cabinet secretary for social justice, communities and pensioners’ rights.

NHS England has updated the procedure for evaluating medicines under the cancer drugs fund. It said the new procedure would prioritise the availability of more effective and promising drugs, though critics said it would reduce the availability of drugs under the scheme. NHS England board papers said modifications were needed as a substantial overspend was projected if the current system remained unchanged.

 Primary care prescribing in Northern Ireland could be more efficient, despite savings of £132m over the last four years, according to the Northern Ireland Audit Office. While the cost of prescribing had fallen by 18% in real terms since 2006, it said there has been a big increase in the volume of prescriptions – from 23 million items in 2000 to almost 39 million in 2013. While acknowledging the efforts to improve prescribing efficiency, including the greater use of generics, an NIAO report said there were variations in prescribing patterns. Primary care prescribing said if all GPs had prescribed as efficiently as average performers, a potential saving of £19m could have been made.